tbuckley/cabot-search huggingface dataset:
Abstract 12593: Type 2 Diabetes Mellitus Polygenic Score Predicts New Onset Diabetes in Patients With Established Atherosclerotic Cardiovascular Disease: A FOURIER Sub-Study
Authors: Filipe A Moura, Frederick Kamanu, Stephen D Wiviott, Robert Giugliano, Jose C Florez, Carolina Roselli, Anthony C Keech, Steven A Lubitz, Patrick T Ellinor, Christian T Ruff, Nicholas F Marston, Marc S Sabatine
Journal: Circulation (2022)

Introduction: Polygenic scores (PS) have been created to predict the risk of developing type 2 diabetes (T2D). We tested whether a contemporary T2D PS predicts new-onset T2D in individuals with established atherosclerotic cardiovascular disease (ACSVD) and across a range of HbA1c and BMI levels. Methods: We analyzed individuals without T2D at baseline with available genotyping data from the FOURIER trial. Genetic risk was characterized using a PS for T2D based on 554 previously identified genome-wide significant single nucleotide polymorphisms. PS was analyzed continuously and categorized as high (top 20%) vs. low (bottom 80%). New-onset T2D was pre-specified and adjudicated centrally according to the American Diabetes Association definitions. HRs were calculated and adjusted for baseline age, sex, BMI, HbA1c, SBP, DBP, HDL-C, and triglycerides. Results: The 9115 participants in this study had mean age of 63±9 yrs and 22.5% were women. Mean HbA1c and BMI were 5.6±0.4% and 28.7±5 kg/m 2 , respectively. A total of 641 new-onset diabetes cases occurred over a median of 2.3 years of follow up. T2D PS significantly predicted new-onset T2D (adjusted HR per 1-SD increase 1.13 95% CI 1.04-1.23, P=0.006). The rates of new-onset T2D in the high and low genetic risk categories were 10.8% vs. 6.6 %, respectively (adjusted HR 1.41 95% CI 1.18-1.69, P&lt;0.001, Panel A). The predictive strength of high genetic risk for T2D appeared strongest in those without key clinical risk factors, namely, those without pre-diabetes [HR 2.01 (1.03-3.89); Panel B] and those with normal weight [HR 2.77 (1.65-4.66); Panel C]. There was no treatment interaction with evolocumab for new-onset T2D. Conclusions: Within a relatively short follow up, we found that a contemporary T2D PS strongly predicted new-onset T2D in patients with established ASCVD. This genetic risk appeared more discriminatory in those lacking traditional clinical risk factors.
Abstract 11834: Ability of Machine Learning Algorithms to Predict Chronic Kidney Disease Using Health Examination Data From the Japanese General Population
Authors: Shin Kawasoe, Takuro Kubozono, ANWAR SALIM, Satoko Ojima, Takeko Kawabata, Yoshiyuki Ikeda, Hironori Miyahara, Tokushige Koichi, Mitsuru Ohishi
Journal: Circulation (2022)

Introduction: There is a large amount of specific health examination data in Japan. Efforts to utilize these data to predict the future onset of cardiovascular diseases are important from the perspective of improving prognosis and QOL as well as medical economy. We evaluated the prediction ability of machine learning algorithms for newly developed 5-year chronic kidney disease (CKD). Methods: Among those who underwent examinations from 2008 to 2018, individuals whose baseline (year X), 1 year later (year X+1), and 5 years later (year X+5) data were available were included. CKD was defined as estimated glomerular filtration rate (eGFR) &lt;60mL/min/1.73m2. Those with CKD in year X or X+1 were excluded. Three different machine learning algorithms, Random Forrest (RF), Logistic Regression (LR), and Multilayer Perceptron (MLP) to predict CKD on year X+5 from single-year data (year X) or consecutive 2 years data (year X and X+1) were assessed, and the predictive ability was compared. Anthropometric measurements, blood pressure and pulse rate, laboratory measurements, and lifestyle related indices were included as explanatory variables. Results: A total of 43,084 participants (age 53.7±10.1 years, male 49.9%) were included and 2,928 individuals (6.8%) had CKD in year X+5. The indices of predictive ability from single-year data were as follows: RF, AUC 0.88, accuracy 0.93, recall 0.99, precision 0.93; LR, AUC 0.89, accuracy 0.93, recall 0.99, precision 0.94; MLP, AUC 0.89, accuracy 0.93, recall 0.99, precision 0.93. Those from multi-year data were as follows: RF, AUC 0.93, accuracy 0.95, recall 0.99, precision 0.95; LR, AUC 0.90, accuracy 0.97, recall 0.99, precision 0.97; MLP, AUC 0.89, accuracy 0.97, recall 0.99, precision 0.97. The variables with the highest importance features were serum creatinine (0.41), age (0.13), medication for hypertension (0.04), and systolic blood pressure (0.03). Conclusions: The ability to predict new onset of CKD was better when using data from two consecutive years than when using data from a single year. The AUCs ranged from 0.89 to 0.93 and were generally better than previously reported risk models using statistical methods. Serum creatinine levels, along with age and blood pressure have been identified as major contributors.
Abstract 11824: Chronic Kidney Disease, Type 2 Diabetes and the Risk of Major Cardiovascular Events in Coronary Artery Disease versus Peripheral Artery Disease Patients
Authors: Lukas Sprenger, Maximilian Maechler, Alexander Vonbank, Barbara Larcher, Arthur Mader, Andreas Leiherer, Axel Muendlein, Heinz Drexel, Christoph H Saely
Journal: Circulation (2022)

Introduction: Chronic kidney disease (CKD) is a paramount indicator of cardiovascular risk and is highly prevalent in patients with established cardiovascular disease, especially among those with type 2 diabetes (T2DM). Peripheral artery disease (PAD) confers an even higher risk than coronary artery disease (CAD). Hypothesis: We hypothesize that cardiovasculr risk compares between PAD and CAD when analyses are stratified by the presence of CKD. Methods: We prospectively recorded major cardiovascular events (MACE) over 10.0±4.7 years in 1356 patients who had stable CAD, of whom 18.4% had CKD, and in 382 patients with PAD, of whom 20.9% had CKD. Four groups were analyzed: CAD patients without CKD (CAD/CKD-; n=1106), CAD patients with CKD (CAD/CKD+; n=250), PAD patients without CKD (PAD/CKD-; n=316) and PAD patients with CKD (PAD/CKD+; n=66). Results: The incidence of MACE was lowest in CAD/CKD- patients (27.2%) and significantly higher in CAD/CKD+ patients (49.6%; p&lt;0.001), in PAD/CKD- patients (40.9%; p&lt;0.001), and in PAD/CKD+ patients (56.9%; p&lt;0.001), who in turn were at a higher risk than CAD/CKD+ or PAD/CKD- patients (p=0.015 and p&lt;0.001, respectively). The risk of MACE did not differ significantly between CAD/CKD+ and PAD/CKD- patients (p=0.063). In Cox regression analysis after multivariate adjustment including gender, age, BMI, hypertension, history of smoking, LDL-C, and HDL-C the presence of PAD versus CAD (HR=1.51 [1.25-1.84]; p&lt;0.001), CKD (HR=1.85 [1.51- 2.26]; p&lt;0.001) and T2DM (HR=1.53 [1.29-1.83; p&lt;0.001) were mutually independent predictors of MACE. Conclusions: We conclude that CKD, T2DM and the presence of PAD versus CAD are mutually independent predictors of MACE.
Abstract 12681: GWAS Meta-Analysis in SCAD, a Women Predominant Ischemic Heart Disease, Reveals Common Variants and Genes Related to Artery Integrity and Tissue-Mediated Coagulation
Authors: David Adlam, Takiy E BERRANDOU, Adrien Georges, Christopher P Nelson, Eleni Giannoulatou, Lijiang Ma, Montgomory Blencowe, Tamiel Turley, Min-Lee Yang, Siiri Iismaa, Ingrid Tarr, David Muller, Stephanie Hesselson, Keerat Junday, Diane Fatkin, Nicolas COMBARET, Jacqueline Saw, Tom Webb, Marysia Tweet, Sharonne N Hayes, Yang Xia, Santhi Ganesh, Timothy M Olson, Jason C Kovacic, Robert M Graham, Nilesh J Samani, Nabila Bouatia-Naji
Journal: Circulation (2022)

Introduction: Spontaneous coronary artery dissection (SCAD) is an understudied cause of acute myocardial infarction due to hematoma formation in coronary arteries primarily affecting women. It is not known to what extent SCAD is genetically distinct from other cardiovascular diseases, including atherosclerotic coronary artery disease (CAD). Methods and Results: Through a meta-analysis of 8 GWAS (1917 cases, 9292 controls of European ancestry), we identified 17 risk loci, including 12 new. Functional annotations pointed at enrichment in enhancer marks of arteries, specifically smooth muscle cells, and strong candidate genes, such as tissue factor gene ( F3 ) on Chr1 near rs1146473 (OR=1.32, P=5.8 х10 -9 ). F3 is novel for SCAD or any cardiovascular disease. The risk allele correlated with F3 lower expression in arteries, supporting a mechanism consistent with hematoma formation. Bayesian gene regulatory networks constructed from expression and genetics data indicated the extracellular matrix organization in arteries as the biological function where most prioritized genes clustered (e.g. COL4A1/A2, HTRA1, and TIMP3 ). Overall, we report substantial polygenicity for SCAD (LDSC: h 2 SNP = 0.71 ± 0.11) and shared genetics with several neurovascular diseases (e.g intracranial aneurysm). Intriguingly, for 6 loci, colocalization analyses showed that SCAD and CAD are likely to share the same causal variants but involve opposite risk alleles (e.g COL4A1/A2 ). In addition, a negative genetic correlation was found between SCAD and CAD (rg=-0.12; P=3.7х10 -3 ), including after conditioning on BP (mt-COJO: rg CAD/SBP =-0.19, P=4.6х10 -6 ). Mendelian randomization analyses indicated higher BP to associate with increased risk for SCAD (beta IVW-SBP =0.05, P=7.6х10 -6 , beta IVW-DBP =0.10, P=1.9х10 -6 ) and CAD (beta IVW-SBP =0.04, P=8.6х10 -49 ; DBP: beta IVW-DBP =0.06, P=1.6х10 -44 ) but not BMI, lipids, or type 2 diabetes, which we confirmed as genetic risk factors for CAD Conclusions: Our results set the stage for future investigation of novel biological pathways relevant to both SCAD and CAD and potential therapeutic and preventive strategies specifically targeting this ischemic disease predominantly affecting women.
Abstract 12633: Factors Affecting Quality of Life Among Patients With Hypertrophic Cardiomyopathy
Authors: YiRae Oh, Geu-Ru Hong, JiYeon Choi, Sang Hui Chu
Journal: Circulation (2022)

Background: Hypertrophic cardiomyopathy (HCM) is the most common genetically determined chronic condition with various clinical symptom and course. Recently, illness perceptions have been known to influence mental health outcomes in patients with HCM. However, limited studies exist on HRQoL and its determinant factors including psychosocial components in patients with HCM. This study aimed to identify factors affecting HRQoL in patients with HCM. Methods: A total of 101 patients with HCM (mean age, 59±12 years; men,74.3%; obstructive type, 43.6%) participated in the study at their regular visits to the outpatient clinic of a university affiliated hospital in Seoul, from July to December, 2020. A questionnaire including the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12) as a measure of physical and mental HRQoL, Korean Illness Perception Questionnaire, Health Promoting Lifestyle II, Patient Health Questionnaire-9 (PHQ-9), and Korean activity scale index (KASI) was used. Multivariable linear regression analysis was conducted to assess determinants of HRQoL. Results: The mean physical component score (PCS) of HRQoL was 47.15±7.66 and mental component score (MCS) was 51.41±8.61. Lower physical functional capacity (β=-.398, p&lt;.001) and higher cyclical timeline beliefs of illness perception (β=-.230, p=.039) were independently associated with lower PCS with 35.9% explanatory power (p&lt;.001). Women (β=-.218, p=.032), depression (β=-.307, p=.004), and stress management (β=.240 p=.042) were identified as independent predictors of MCS with 39.7% explanatory power (p&lt;.001). Conclusions: This study shows the important role of illness perception in determining the physical HRQoL in patients with HCM. Interventions aimed at changing Illness perception and reducing depression may be promising approaches to improve HCM patients’ HRQoL.
Abstract 12165: Transcatheter Mitral Valve Repair is Safe in Older Adults: Insight From the Nationwide Inpatient Sample Database
Authors: Kahtan Fadah, David E Winchester
Journal: Circulation (2022)

Introduction: Transcatheter mitral valve repair (TMVR) is an effective treatment for symptomatic mitral insufficiency, however in elderly patients is limited. We compared outcomes clinical outcomes, cost, and complications in adults aged ≥80 years old compared to &lt; 80 years old. Methods: We identified all cases of transcatheter mitral valve repair in patients admitted to hospitals in the United States (US) from 2016 to 2019 using the National Inpatient Sample. We compared outcomes between older adults and younger population using 79 years of age as the cutoff. Results: Out of 3130 patients who underwent TMVR , 33.42 % of patients were over the age ≥80 of years. Half of those patients were female (49.91%). Older patients ≥80 years of age were more likely to have congestive heart failure (79.36 versus 70.13, p&lt;.0001), dyslipidemia (57.64% versus 51.0%, p&lt;.0001), chronic kidney disease (34.66% versus 25.39%, p&lt;.0001), and coronary artery disease (58.51% versus 51.141%, p&lt;.0001). While patients younger than 80 years of age more frequently had diabetes mellitus(29.83% versus 19.92%, p&lt;.0001), hypertension (30.12% versus 21.30%, p&lt;.0001), and smoking(9.09% versus 0.72%, p&lt;.0001). Hospital mortality was lower in patients 80 years of age or older (2.56% versus 4.46%, p&lt;.0001). In addition, hospital length of stay and total charges were lower in the older group (4.93±6.62 days versus 10.85±13.61 days), and ( $222933 ±155969 versus $288776 ±314288, p &lt;.0001). However, multivariable analysis after adjusting for baseline comorbidities mentioned above did not show significant difference in mortality between the two groups (OR 0.792, CI 0.501-1.252). Conclusions: After adjustment for baseline characteristics, patients ≥80 years old and undergoing TMVR have similar in-hospital mortality to patients under age 80. Care for the ≥80 cohort was more costly. The present analysis suggests TMVR is safe in older adults.
Abstract 11601: Association Between Remnant Cholesterol and Coronary Plaque Features: The Miami Heart Study at Baptist Health South Florida
Authors: Renato Quispe, Reed Mszar, Shubham Lahan, Javier Valero Elizondo, Matthew Budoff, Ricardo C Cury, Theodore Feldman, Lara Arias, Michael J Blaha, Michael D Shapiro, Ron Blankstein, Garima Sharma, Miguel Cainzos, Khurram Nasir, Jonathan Fialkow
Journal: Circulation (2022)

Introduction: Remnant particles, the product of partial metabolism of triglyceride-rich lipoproteins, have been associated with atherosclerotic cardiovascular diseases (ASCVD), independent of low-density lipoprotein cholesterol (LDL-C). This study aims to further examine the role of remnant cholesterol (RC) in atherogenesis by assessing its association with plaque characteristics. Methods: After excluding individuals on statin therapy (n=527), we included 1,832 statin-naïve participants from the Miami Heart Study, a prospective cohort of clinical ASCVD-free individuals in Miami (2015-2018) evaluated using coronary computed tomography angiography (CTA). RC was estimated as non-high density lipoprotein cholesterol minus LDL-C. Multivariable logistic regression models were used to estimate the association between low/high RC/LDL-C groups (defined by &lt; or ≥ medians) and plaque features. Results: Mean age of participants was 52.5±6.7 years, 54% women, 49.5% Hispanic. Median LDL-C and RC were 129.1 and 21.6 mg/dL, respectively. For each SD increase in RC levels, the odds of having non-calcified coronary plaque increased (OR 1.19 [95% CI 1.07-1.33]) and so did the segmental involvement score (OR 1.05 [95% CI 1.01-1.09]) independent of traditional risk factors including LDL-C. The prevalence of coronary plaque features per RC/LDL-C group are shown in Table. Among those with low LDL-C, having high RC conferred a significantly higher risk of non-calcified plaque (OR 1.61 [95% CI 1.11-2.32]) compared to having low RC, although associations were not statistically significant with other plaque features (Table). Conclusions: In asymptomatic individuals with low LDL-C, elevated RC was independently associated with non-calcified plaque.
Abstract 12677: Intensive Cardiac Rehabilitation Outcomes in Patients With Heart Transplant
Authors: S. Hammad Jafri, Kyari Sumayin Ngamdu, Muhammad Baig, Andrew M Freeman, Dean Ornish, Alan R Morrison, Wen-Chih H Wu
Journal: Circulation (2022)

INTRODUCTION Heart Transplant (HT) is gold standard for patients with Heart failure (HF) with end stage disease, however it requires ideal post-surgical recovery which includes medications &amp; Cardiac Rehabilitation (CR). Clinical trials have shown that CR can reduce morbidity &amp; mortality, increase exercise tolerance and reduce psychological symptoms in patients with HT. Intensive Cardiac rehabilitation (ICR) has proven benefits for patients with HF but the outcomes of ICR in patients with HT are unknown. Methods: Retrospective cohort study of 1413 patients from Jan-2016 to Dec-2020. ICR sessions consists of 4-hours two times per week for 9-weeks of lifestyle modification aiming at high fiber low fat diet, peer support, exercise and stress reduction.Patients were divided into two groups: 18 patients in HT group and 1395 patients in HF group. Primary endpoints were change in body mass index (BMI), exercise minutes per week (EMW) and depression scores (CESD). Secondary endpoints includes change in blood pressure (BP), cholesterol (chol), low density lipoprotein (ldl), high density lipoprotein (hdl), triglycerides (tgl) and health status (SF-36 physical &amp; mental composite scores). T test was used to compare variables between two groups. Linear regression was used to adjust for difference in baseline variables. Results: Table 1 explains baseline characteristics and demographics of both groups. Table 2 shows outcomes of both groups pre and post-ICR. Conclusions: Significant Improvement in ICR outcomes were achieved for both groups. There is no difference among groups when improvements were compared with each other except for chol which has improved more in patients with HF.
Abstract 11250: Historical Neighborhood Redlining and Cardiovascular Risk in Patients With Chronic Kidney Disease: Results From Chronic Renal Insufficiency Cohort
Authors: Sadeer Al-Kindi, Issam Motairek, Khurram Nasir, Michael E Farkouh, Laurence Sperling, Jackson T Wright, Mirela A Dobre, Mahboob Rahman, sanjay Rajagopalan
Journal: Circulation (2022)

Background: Neighborhood redlining was established by the government-sanctioned Home Owners' Loan Corporation (HOLC) in the 1930s aimed to develop neighborhood risk assessment for mortgage applications in the United States. Redlining has resulted in residential segregation and has contributed to persistent systemic racism. Objectives: We sought to investigate the association between redlining and prevalent and incidence cardiovascular disease (CVD) in patients with chronic kidney disease (CKD). Methods: We linked participants from the Chronic Renal Insufficiency Cohort (patients with mild to moderate CKD enrolled 2003-2008 and followed prospectively) with historical redlining risk groups using participant residential address at enrollment. HOLC groups neighborhoods into risk groups (A-D, with A being lowest risk and D being highest risk). We examined the association between redlining groups with prevalent and incident cardiovascular events Results: A total of 1720 participants were included: 109 (6.3%) in group A, 305 (18%) in group B, 753 (44%) in group C, and 553 (32.2%) in group D. Overall, increasing neighborhood HOLC risk was associated with increased proportion of Black and Hispanic residents, younger age, proteinuria, higher systolic BP, and high sensitivity troponin levels (all P&lt;0.01). In multivariable models, group B (Odds Ratio [OR] 2.34 (95% CI: 1.32-4.15), P=0.003), group C (OR 2.31 (1.34-3.98), P=0.003) and group D (OR 2.10 (1.21-3.65), P=0.009) were associated with increased CVD at baseline (vs group A). Among 1118 participants without baseline CVD, group D was associated with increased risk for HF or all-cause death (adjusted HR 2.63 (1.31-5.28), P=0.006) which remained unchanged after further adjustment for BNP and high-sensitivity troponins (D vs A: HR 2.55 (1.27-5.13), P=0.008). Conclusions: Historical neighborhood redlining is associated with prevalent CVD and incident heart failure/death in a contemporary cohort of patients with CKD, enrolled more than 6 decades after the redlining practices were abolished. Future studies should focus on investigating the mechanisms of this relationship and the impact of residential segregation on cardiovascular health.
Abstract 11887: Self-Pay Insurance Status is Associated With Failure of Medical Therapy in Patients With Acute Uncomplicated Type B Aortic Dissection
Authors: brian J fazzone, Erik Anderson, Sara Hensley, Martha Weaver, Dan Neal, Samir Shah, Salvatore T Scali, Thomas Huber, Gilbert R R Upchurch, George Arnaoutakis, Michol Cooper
Journal: Circulation (2022)

Introduction: Traditionally, acute uncomplicated type-B aortic dissections (auTBAD) are managed with best medical therapy. Recent literature has focused on identifying high-risk patients who might benefit from early endovascular repair based on dissection anatomy characteristics, but socioeconomic factors are less often considered despite relationships between disparities and vascular disease outcomes. Aim: To understand the presentation, management, follow-up, and outcomes among patients presenting with auTBAD, focusing on insurance status. Methods: In this single center, observational study, demographics, medication prescription patterns, follow-up, and outcomes of patients with auTBAD managed medically from 2013-2018 were analyzed. Patients with complicated, chronic, type-A dissection, PAU, or IMH were excluded. Area deprivation index (ADI) was determined from patient’s home addresses. Comparisons between age, ADI, prescription patterns, follow-up, and outcomes were made between groups based on payer status. Payer status was defined as insured or self-pay (i.e., no insurance). Results: 57 patients presented with auTBAD and were managed medically. 30% of patients were self-pay. Self-pay patients were from areas with higher deprivation indices (74 vs 62, p = 0.041), presented with higher blood pressures (138 vs. 118 mmHg, p = 0.006), and were on fewer home antihypertensives (0.29 vs 0.95, p = 0.030). Self-pay patients required more antihypertensives at discharge (3.6 vs 3.0, p = 0.049) and were less likely to follow-up (29% vs. 70%, p = 0.008). Self-pay patients had worse freedom from aortic intervention (p = 0.023), were more likely to represent urgently or emergently for repair (75% vs 0%, 0.033), and trended towards earlier time to intervention (8.5 months vs. 30 months, p = 0.060). Conclusions: Self-pay insurance was associated with worse hypertensive disease characteristics, follow-up patterns, and long-term outcomes in patients presenting with auTBAD managed with medical therapy. These findings suggest prohibitive compliance and surveillance trends in this cohort, which underscores the importance of considering patient factors, particularly payer status, when deciding between auTBAD treatment options.